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Annals of African Medicine, Vol. 10, No. 3, July-September, 2011, pp. 256-257 Letter to Editor Antituberculosis drug resistance pattern among newly diagnosed pulmonary tuberculosis patients in south west Nigeria Olusoji Daniel1, Eltayeb Osman2, Ayodele Awe3, Sam Ogiri3, Wole Lawal4, Samson Sobaloju5 1 Department of Community Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria Code Number: am11054 PMID: 21912015 Dear Sir, The first drug for the treatment of tuberculosis (TB) was introduced in the 1940s and since then, there has been documented evidence of resistance to anti-TB drugs. [1] The World Health Organization has estimated that among new TB patients in Nigeria, about 1.8% have Multidrug Resistant-TB [2] (i.e., resistance to both rifampicin and isoniazid). We therefore embarked on the study to assess the anti-TB drug resistance pattern in newly diagnosed pulmonary TB patients in two states of Oyo and Osun, South West Nigeria. The study was a retrospective study of newly diagnosed TB patients attending treatment centers in the two states whose sputum specimens were subjected to culture and drug-sensitivity testing to both first- and second-line anti-TB medications at the institute of tropical medicine Antwerp, Belgium. A total of 23 TB patients were enrolled in this study. There were 13 males (57.9%) and 10 females (42.1%). Of the 23 isolates, 4 (17.4%) were resistant to any one of the four first-line anti-TB drugs; one (4.3%) isolate was isoniazid monodrug resistant, two (8.6%) to rifampicin, and one (4.3%) isolate was streptomycin monodrug resistant. None of the patients had resistance to all first-line anti-TB drugs. Resistance to second-line drugs were to ofloxacin, 1 (4.3%) and 3 (13%) to cycloserine. Multidrug resistance (i.e., resistance to both rifampicin and isoniazid) was not observed among the study population. The study has demonstrated resistance to at least one anti-TB drug in new patients. The implication of such initial resistance is that when such patients are treated with standardized treatment regimen recommended by the world health organization as is the case in developing countries, there is a propensity for the amplification of resistance to other anti-TB drugs, thereby leading to an increase in the incidence of treatment failure and relapse, [3],[4] and increase morbidity and mortality in these patients. [5],[6] The presence of resistance to anti-TB drugs among new TB patients has also highlighted the need for all TB patients to have access to culture and drug susceptibility testing (DST) services, so that appropriate treatment can be prescribed to patients from the outset and prevent the amplification of resistance. This challenge can be overcome in developing countries with the recent introduction of newer molecular technologies such as the line probe assays (an example is Hains Technique) and the recently introduced Gene Xpert which are rapid technologies that can detect resistance to Isoniazid and/or Rifampicin, the most potent anti-TB drugs. These new technologies will greatly assist in the appropriate diagnosis and subsequent appropriate management of drug-resistant TB patients. The country needs to build the laboratory capacity for culture and DST and make the service available, affordable, and accessible to the patients who need them. References
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